How junior doctors rationalise anxiety as just another day on the wards

A doctor recently told me she had palpitations whenever her pager sounded. We were discussing how relieved she felt that a new role she was about to begin didn’t require a pager. It struck me how offhanded her comment was; how she associated the pager with an unenjoyable job rather than it triggering an anxiety response.

A 2013 beyondblue study found 41 per cent of medical students felt doctors believed a doctor with a mental health condition is less competent. I’ve seen the impact of that stigma first-hand. Junior doctors rationalise clear signs and symptoms of anxiety and depression as ‘just another day on the wards’.

Of course it makes sense that you feel stressed and on edge. Sixteen-hour days are common and fourteen-hour days are standard. Your to-do list seems to get longer while you’re walking towards the first patient on that list. You still haven’t been told where in the state your next term will be, and you’re still feeling sleep deprived after the last round of night shift.

It’s ‘normal’ that your mind is in overdrive after your shifts, so it’s ‘normal’ that you have trouble sleeping. It’s ‘normal’ that you’ve been avoiding the Head of the Unit because you lodged your overtime request and you’re worried they’ll penalise you – somehow. When you display these behaviours on a regular basis, they could actually be signs of anxiety.

Justifying symptoms of anxiety

Anxiety affects how a person thinks, acts, and feels emotionally and physiologically. It impacts a person’s quality of life and day-to-day-functioning.

Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life.

You’re a junior doctor – you probably know these things. But take a moment of reflection: have you experienced these signs or symptoms recently? How recently? How often? How much has it changed your behaviour?

A 2013 national beyondblue survey of doctors and medical students found approximately 9 per cent of doctors reported having ever been diagnosed with or treated for an anxiety condition. That’s almost double the rate of the Australian population who report experiencing anxiety conditions (5.9 per cent).

Funny thing though – doctors often try to convince themselves that as people who understand the ins and outs of health, they are immune to mental health conditions. In fact, that beyondblue research found 7 per cent felt that doctors should be able to avoid depression and anxiety disorders and 41.5 per cent felt that doctors with a history of anxiety or depression are less likely to be appointed than other doctors.

How unhealthy workplace environments place stress on junior doctors

We work highly stressful jobs, yet half the time it’s not patient care that is stressing us. The high-stress environment in which doctor’s work makes us more vulnerable to developing mental health conditions such as anxiety.

Factors include:

heavy workloads

long working hours

shift work

uncertainty of short-term contracts and relocations

Inability to access leave or being refused leave you are entitled to

bullying and harassment

home-work stress

Many junior doctors fear claiming contractual entitlements such as overtime and annual, personal and sick leave. It’s uncommon for junior doctors to confidently request time to attend a course or conference, even though it might be necessary for their career development.

beyondblue research found the most common source of work stress reported by doctors was related to balancing work and personal responsibilities (26.8 per cent). Other sources of work related stress included too much to do at work (25 per cent), responsibility at work (20.8 per cent), long hours (19 per cent) and fear of making mistakes (18.7 per cent).

I’ve seen so many junior doctors refuse to ask for help despite completely untenable workloads, or refuse to report rosters that are in clear breach of the EBA. I also know many junior doctors don’t speak up about poor experiences during a term, from management failing to offer quality learning opportunities to bullying. Counting down the hours left in a shift or the days left in a term might make you feel better, but it’s not going to help junior doctors who proceed you. You need to seek help from your manager to reduce your workload. You should provide feedback to management about any issues that add to your stress levels. There are systems in place and associations and unions to support you in providing that feedback. You can speak up and you should: if not for you, for the junior doctors that will follow. Your feedback can create improved working conditions for everyone.

Your job is not your life: work-life balance is a protective factor against mental health conditions

Workplace factors, such as long hours and heavy workloads, can impact doctors at any level to the same degree as having high self-expectations and fear of failure or humiliation. No-one is immune to stress; unmanaged stress creates a breeding ground for anxiety.

The onset of stress often begins when you compromise on necessary lifestyle factors such as sleep, nutritious food, exercise and seeing family and friends. Usually your social life is the first sacrifice. You miss a birthday or a family dinner to do overtime, and one day you realise you haven’t met your close friend’s partner… and they’re now engaged. Surely you could hand over those last few jobs to cover and make those non-urgent phone calls tomorrow?

Your health is just as important as your patients’

Satiric medical website GomerBlog jokes about the best places in a hospital for interns to cry. In an episode of Scrubs, the character J.D. runs into a broom cupboard to hide from having to resuscitate a patient for the first time. His colleague Elliot Reid had already beaten him to the hiding place. These comedic references are so (unnervingly) funny because there are truths in them. I’ve seen junior doctors hide during shifts. If you do it once or twice, you can write it off as nerves or a tough day. If you’re avoiding things regularly, it’s yet another sign that you could be experiencing anxiety.

I once saw a junior doctor walk into the doctors’ office clearly exhausted. When asked why, he told me he realised at 3am that he had forgotten to complete some blood slips during the previous shift. As a routine task, he could have called a cover doctor who was on shift to complete the slips. Instead, he returned to work to finish the task himself. He deprived himself of considerable sleep to do so and had turned up to work fatigued. Over-conscientiousness is a common behaviour among junior doctors who fear making minor mistakes, but it’s also a potential sign of anxiety.

That doctor might not have considered the impact of choosing work over the sleep he needed but many junior doctors do make conscious decisions to sacrifice basic self-care. Junior doctors need to stop glorifying these unhealthy behaviours. If you make a mistake at work because you came in at 3am to do bloods, or you only sleep four hours a night because ‘that’s all I need’, it is you that has to live with the consequences of these decisions. It’s not heroic to live off takeaway or frozen meals, or worse – not eat, because you ‘are just too busy’. You should make time for your own health. It should be just as important as your patients’ wellbeing.

I schedule time to swim after work, which I prioritise even more when I’m heading into a busy work period. It’s my way to wind down so that my time at home is for me. In the pool I think about my day and my work. That balance between work and home gives me reserve to draw from on more challenging days – when a patient has had a terrible outcome or it’s been a really busy shift or week.

When you allow work to consume your life – sacrificing your physical, emotional and social wellbeing –you are very vulnerable to developing a mental health condition. Anxiety is the most common; one in four people will experience anxiety at some point in their life, compared to one in six who will experience depression. My advice is this: decide the life you want to lead and live it. Whatever you want in your ideal life – such as hobbies, exercise or socialising – strive for that. That ‘less busy’ time you’re hoping for won’t exist; build your ideal life now. Your mental health will be better for it.

About The Author

Jessica Dean is a board director of beyondblue and sits on advisory groups for beyondblue’s Doctors’ Mental Health Program and National Suicide Prevention Campaign and Strategy. Jessica is a junior doctor pursuing training in intensive care medicine and is also completing a law degree.